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92 Cards in this Set

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Pheochromocytoma: most secrete what? (3)
epinephrine
NE
dopamine
Pheochromocytoma: what substances are elevated?
VMA in urine
catecholamines in plasma
Pheochromocytoma: associated with what syndrome(s)?
MEN II and III
Pheochromocytoma: treatment and its mechanism?
alpha-antagonists: Phenoxybenzamine is a nonselective, IRREVERSIBLE alpha blocker
Pheochromocytoma: types of symptoms?
Episodic hyperadrenergic symptoms (5 P's):
1. Pressure
2. Pain (headache)
3. Perspiration (tachycardia)
4. Palpitations
5. Pallor
Pheochromocytoma: Rule of 10's?
10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids
10% familial
Pheochromocytoma: typical presentation of symptoms in general?
"spells" - relapse and remit
MEN I: aka?
Wermer's Syndrome
MEN I: affects what organs?
3 "P" organs:
1. Pancreas - ZE syndrome, insulinomas, VIPomas
2. Pituitary - prolactinomas
3. Parathyroid
MEN I: how does it present?
kidney stones and stomach ulcers
MEN: inheritance patterns of all forms?
autosomal dominant
MEN II: aka?
Sipple's syndrome
MEN II: presentation?
1. medullary carcinoma of the thyroid
2. pheochromocytoma
3. parathyroid tumor
MEN III: presentation?
1. medullary carcinoma of the thyroid
2. pheochromocytoma
3. oral and intestinal ganglioneuromatosis (mucosal neuromas)
MEN: gene assoc. w/ types II and III?
ret gene
Hypothyroidism: symptoms?
cold intolerance
hypoactivity
weight gain
fatigue
lethargy
dec appetite
constipation
weakness
dec reflexes
myxedema (facial/periorbital)
dry, cool skin
coarse, brittle hair
D/Dx: cold intolerance, hypoactivity, weight gain, fatigue, lethargy, dec appetite, constipation, weakness, dec reflexes, myxedema (facial/periorbital); dry, cool skin; coarse, brittle hair
hypothyroidism
Hypothyroidism: labs?
high TSH (sensitive test for primary hypothyroidism)
low total T4
low free T4
low T3 uptake
Hyperthyroidism: symptoms?
heat intolerance
hyperactivity
weight loss
chest pain/palpitations
arrhythmias
diarrhea
inc refexes
warm
moist skin
fine hair
D/Dx: heat intolerance, hyperactivity, weight loss, chest pain/palpitations, arrhythmias, diarrhea, inc refexes, warm, moist skin, fine hair
hyperthyroidism
Hyperthyroidism: labs?
low TSH (if primary)
high total T4
high free T4
high T3 uptake
What is Reidel's thyroiditis? What does it cause?
thyroid replaced by fibrous tissue

causes hypothyroidism
Grave's dz: cause?
autoimmune hyperthyroidism w/ thyroid-stimulating/TSH receptor antibodies
Grave's dz: symptoms?
ophthalmopathy (proptosis, EOM swelling)
pretibial myxedema
diffuse goiter
D/Dx: ophthalmopathy (proptosis, EOM swelling), pretibial myxedema, diffuse goiter
Grave's dz
What type of hypersensitivity is Graves' dz?
type II
Common time for Graves' dz to present?
during stress (i.e. childbirth)
What is thyroid storm?
underlying Graves' dz w/ a stress-induced catecholamine surge --> may cause death
Hashimoto's thyroiditis: cause?
autoimmune disease causing hypothyroidism
Hashimoto's thyroiditis: may occur due to what?
follicular rupture w/ thyrotoxicosis
Hashimoto's: clinical presentation?
slow course
moderately enlarged, nontender thyroid
Hashimoto's: histo? associated cell type?
lymphocytic infiltrates w/ germinal centers

Hurthle cells
Hashimoto's: what antibodies?
antimicrosomal antibodies
antithyroglobulin antibodies
Subacute thyroiditis: aka?
de Quervain's thyroiditis
Subacute thyroiditis: what is it?
self-limited hypothyroidism often following flulike illness
Subacute thyroiditis: symptoms?
elevated ESR
jaw pain
early inflammation and very tender thyroid gland
D/Dx: elevated ESR, jaw pain, early inflammation and very tender thyroid gland
Subacute thyroiditis
Subacute thyroiditis: how may it present early in course?
as hyperthyroid
Toxic multinodular goiter: why do you get it?
iodine deprivation followed by iodine restoration
Toxic multinodular goiter: causes release of what?

are the nodules malignant?
T3 and T4 released

nodules NOT malignant
Jod-Basedow phenomenon?
assoc w/ Toxic multinodular goiter

=thyrotoxicosis if a patient w/ endemic goiter moves to iodine-replete area
Thyroid CA: five types?
1. papillary carcinoma
2. follicular carcinoma
3. meduallary carcinoma
4. undifferentiated/anaplastic carcinoma
5. lymphoma
Papillary carcinoma description?
most common thyroid CA
excellent prognosis
"ground glass" nuclei (Orphan Annie eyes)
psammoma bodies
increased risk w/ childhood irradiation
D/Dx: most common thyroid CA, excellent prognosis, "ground glass" nuclei (Orphan Annie eyes), psammoma bodies, increased risk w/ childhood irradiation
papillary thyroid carcinoma
Follicular carcinoma:
prognosis?
appearance?
good prgnosis
uniform follicles
Medullary carcinoma:
from what cells?
produce what?
appearance?
assoc with what syndromes?
-from parafollicular "C cells"
-make calcitonin
-look like sheets of cells in amyloid stroma
-MEN II and III
Anaplastic/undifferentiated carcinoma of thyroid:
older patients
very poor prognosis
Lymphoma: what thyroid issue is it associtaed with?
associated with Hashimoto's thyroiditis
Cretinism:
-when do endemic cases occur?
-when do sporadic cases occur?
Endemic cretinism cases occur wherever endemic goiter is prevalent (lack of dietary iodine).

Sporadic cretinism is due to a defect in T4 formation or developmental failure in thyroid formation.
Cretinism: findings?
pot-bellied
pale
puffy-faced child with prtruding umbilicus and protuberant tongue
Cretinism:
-what does cretin mean and why was it goven this name?
-what part of the world is it still common in?
Cretin means Christlike. Those affected were considered retarded as to be incapable of sinning. Still common in China.
Acromegaly:
-due to?
-if it occurs in kids?
-medical treatment?
Due to excess GH in adults. Is gigantism in kids (epipheses haven't yet closed).


Treat with octreotide.
Acromegaly: findings?
Findings: large tongue w/ deep furrows, deep voice, large hands and feet, coarse facial features, impaired glucose tolerance (insulin resistant)
When is it normal to have an increased GH level?
stress
exercise
hypoglycemia
Primary Hyperparathyroidism:
-usually due to?
-serum findings?
-what is high in urine?
-Usually an adenoma.

-Serum findings: hypercalcemia, hypercalciuria (rena stones), hypophosphatemia, elevated PTH

-eleveated cAMP in urine
Primary hyperparathyroidism:
-Presentation?
"Stones, bones, and groans."

-bone pain: Osteitis fibrosa cystica (von Recklinghausen's syndrome) - cystic bone spaces fill with brown fibrous tissue --> bone pain

May present with weakness and constipation ("groans").

"Stones" = kidney stones

Often asymptomatic.
Secondary hyperparathyroidism:
-most often due to?
-serum findings?
Caused by secondary hyperplasia due to low Calcium. Most often in chronic renal disease.

Serum: hypocalcemia, hyperphosphatemia, elevated PTH
Secondary hyperparathyroidism:
-what bone problem is seen?
Renal osteodystrophy - bone lesions due to secondary hyperparathyroidism due to renal disease.
Hypoparathyroidism:
-findings?
-due to? assoc with what syndrome?
Hypocalcemia and tetany.

Due to accidental surgical removal (thyroid surgery) or Di George syndrome.
Hypoparathyroidism:
-Chvostek's sign?
-Trousseau's sign?
Chvostek's sign: tap facial nerve --> contraction of facial muscles

Trousseau's sign: occlusion of brachial artery with BP cuff --> carpal spasm
Pseudohypoparathyroidism:
-due to?
-findings?
due to autosomal-dominant kidney unresponsiveness to PTH

hypocalcemia, shortened 4th/5th digits, short stature
Hypercalcemia:
causes? (mneumonic)
CHIMPANZEES:
-Calcium ingestion (milk-alkali syndrome)
-Hyperparathyroid
-Hyperthyroid
-Iatrogenic (thiazides)
-Multiple myeloma
-Paget's disease
-Addison's disease
-Neoplasms
-Zollinger-Ellison syndrome
-Excess vitamin D
-Excess vitamin A
-Sarcoidosis
Pituitary adenoma:
-what type is most common? signs?
Prolactinomas are most common: ammenorrhea, galactorrhea, low libido, infertility.
Pituitary adenoma: treatment?
Treatment: bromocriptine (dopamine agonist) causes shrinkage.
Acute manifestations of diabetes mellitus?
polydipsia
polyuria
polyphagia
weight loss
DKA (type 1)
hyperosmolar coma (type 2)
unopposed secretion of GH and epinephrine (exacerbates hyperglycemia)
Chronic manifestations of diabetes mellitus:
-nonenzymatic glycosylation causes what?
Nonenzymatic glycosylation:
1. small vessel disease (diffuse thickening of basement membrane) --> retinopathy, glaucoma, nephropathy

2. Large vessel atherosclerosis, CAD, peripheral vascular occlusive disease and gangrene, cerebrovascular disease
What causes retinopathy in DM?
hemorrhage
exudates
microaneurysms
vessel proliferation
What's seen with nephropathy due to DM?
-nodular sclerosis
-progressive proteinuria
-chronic renal failure
-arteriosclerosis leading to HTN
-Kimmelstein-Wilson nodules
Chronic manifestations of diabetes mellitus:
-what problems are associated with osmotic damage?
Osmotic damage:
1. neuropathy - motor, sensory, and autonomic degeneration

2. cataracts - sorbitol accumulation
Genetic predisposition for diabetes?
type 1 - weak, polygenic

type 2 - strong, polygenic
Diabetes associated with HLA system?
Type 1 is associated with HLA-DR3 and DR4.
Which type of diabetes most often presents with classic symptoms (polyuria, polydipsia, thirst, weight loss)?
more common presentation in Type 1, but does occur in Type 2
What causes diabetic ketoacidosis?
Usually due to an increase in insulin requirements from an increase in stress (i.e. infection).

Excess fat breakdown and increased ketogenesis from the increase in FFAs --> ketone bodies.
Signs/symptoms of DKA?
-Kussmal respirations = rapid/deep breathing
-hyperthermia
-nausea/vomiting
-abdominal pain
-psychsosis/dementia
-dehydration
-fruity breath odor: due to exhaled acetone
Labs in DKA?
-hyperglycemia
-high H+
-low HCO3- (anion gap metabolic acidosis)
-high blood ketone levels
-leukocytosis
-hyperkalemia (but depleted intracellular K+)
Complications of DKA?
-life-threatening mucormycosis
-Rhizopus infection
-cerebral edema
-cardiac arrhythmias
-heart failure
Treatment of DKA?
fluids, insulin, and potassium

glucose if necessary to prevent hypoglycemia
What is diabetes insipidus?

Caused by?
Characterized by intensive thirst and polyuria together with an inability to cncentrate urine due to:
1. lack of ADH (central DI)
2. lack of renal response to ADH (nephrogenic DI)
4 causes of central DI?
1. pituitary tumor
2. trauma
3. surgery
4. histiocytosis X
4 causes of nephrogenic DI?
1. hereditary
2. secondary to hypercalcemia
3. secondary to lithium
4. secondary to demeclocycline
How do you diagnose diabetes insipidus?
Water deprivation test: urine osmolality does not increase.
Findings in DI?
-urine specific gravity <1.006
-serum osmolality >290 mOsm/L
Treatment of both types of DI?
Adequate fluid intake.

1. central DI - intranasal desmopressin (ADH analog)

2. nephrogenic DI - HCTZ, indomethacin, or amiloride
SIADH: classic findings?
1. excessive water retention
2. hyponatremia
3. urine osmolarity > serum osmolarity
SIADH: what problem can low serum sodium cause?
low serum sodium can cause seizues (must correct slowly)
SIADH: treat with?
treat with demeclocycline or water restriction
SIADH: causes?
1. ectopic ADH (small cell lung cancer)
2. CNS disorders/head trauma
3. pulmonary disease
4. drugs (e.g. cyclophosphamide)
Carcinoid syndrome:
-what is it?
-most common tumor of what organ?
A rare syndrome caused by carcinoid tumors (neuroendocrine cells), especially metastatic small bowel tumors, which secrete high levels of 5-HT.

Most common tumor of the appendix.
Carcinoid syndrome:
-when is it NOT seen?
-results in recurrence of what symptoms?
NOT seen if tumor is limited to the GI trat (serotonin undergoes 1st pass metabolism in the liver)

Symptoms: diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease
Carcinoid tumor: what's present in the urine?
high 5-HIAA in urine
Carcinoid tumor:
-what is the rule of 1/2?
-derived from what cells?
-treat with?
Rule of 1/3:
-1/3 metastasize
-1/3 present with second malignancy
-1/3 multiple

-derived from neuroendocrine cells of GI tract

-treat with octreotide
Zollinger-Ellison syndrome:
-what is it?
-what does it cause?
-may be associated with what syndrome?
=gastrin-secreting tumor of pancreas or duodenum

-causes recurrent ulcers

-may be associated with MEN I